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Old Medical Images: Treating Tuberculosis with an Artificial Pneumothorax

Something new for our readers. A look at some of the quirks and forgotten treatments and beliefs of the medical world of the past.

Posted Monday September 2, 2013

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Generally, we don’t think of a pneumothorax as something we want. Often called a collapsed lung, it happens when air gets into the space between the chest wall and the lung and forces the lung down.

Pneumothoraces can be big or small, dangerous or benign, but current medical thinking is to let/make them go away, not encourage them.

So what the heck are these people doing here?

Well, back in 18th century France doctors noticed that tuberculosis patients with pneumothoraces seemed to do better. Eventually a theory evolved that this lessened the growth of the tuberculosis organism by reducing the oxygen supply and methods were developed to more or less safely and easily collapse an affected lung.

That’s what these guys are demonstrating. This is meant to be a quasi-humorous slide to show to patients, laypeople and students to illustrate the basic principle of introducing air into the lung cavity. Of course they did not use a funnel and a giant watering can labeled “air” (“Luft” in German). They used a bicycle pump, because of course you would. Their pumps were a little fancier, with continuous airflow from electricity and dials and gauges, but that was the basic mechanism to force the lung down.

Did it work? Hard to say. Our modern controlled study protocols hadn’t really started in clinical medicine in the late 19th century up to the dawn of the antibiotic age of TB treatment. TB was almost always a chronic disease that could wax and wane in a single patient. In addition there was no way to predict whether or not one patient would get better, or progress on to serious disability and even death. So some patients always got better no matter what, and some did not. Naturally, whenever a patient got better after a pneumothorax procedure it was thought to be due to the procedure, and if they didn’t, well, nothing’s 100%, they waited to long, etc., etc.

Of note TB is still a serious health problem, causing 2-3 million deaths worldwide per year. But we have forgotten just how amazingly awful a health problem it was for hundreds of years. Up until the end of the 19th century the infection rate in Europe was basically 100%. Everybody was infected. What John Bunyan called “the captain of all these men of death” was everywhere and it killed and killed. Up to 25% or more of ALL deaths were due to tuberculosis.

So what are the two shirtless guys doing there? Your guess is as good as mine.

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